Provider Demographics
NPI:1396581625
Name:HANNIGAN, HEATHER CARISSA (LE)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:CARISSA
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 SE BELMONT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1983
Mailing Address - Country:US
Mailing Address - Phone:503-545-5965
Mailing Address - Fax:
Practice Address - Street 1:6118 SE BELMONT ST STE 410
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1983
Practice Address - Country:US
Practice Address - Phone:503-593-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10243881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist